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This is VAERS ID 306670

Case Details

VAERS ID: 306670 (history)  
Form: Version 1.0  
Age: 0.33  
Sex: Male  
Location: Indiana  
Vaccinated:2007-12-20
Onset:2008-03-01
   Days after vaccination:72
Submitted: 2008-03-07
   Days after onset:6
Entered: 2008-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B12SCB / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0072U / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015D / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1244U / 2 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Intussusception, Surgery
SMQs:, Gastrointestinal obstruction (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: no
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Air contrast enema (+) for Ileocolic IS in the transverse colon. CT (+) for IS.
CDC Split Type:

Write-up: Intussusception requiring surgical reduction occurred 3/1/08. 03/14/2008 MR received for DOS 3/01-04/2008 with D/C DX: S/P Exploratory Laparotomy. Reduction of Intussusception. Appendectomy. Infant presented to local hospital with abdominal pain, vomiting and bloody stools. Recent URI. Intussusception noted on abdominal CT and pt transfered to current facility for tx. Air enema unsuccessful at reduction and pt to OR for Ex Lap and reduction of IS. pt experience post-op fevers. Taking po on POD#2 and D/C home on POD#3. Seen again in ER 3/5/08 after no BM and fussiness. Glycerine supp given for constipation.


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